Provider Demographics
NPI:1295167674
Name:RYNO, MARRIANNE (RPH,)
Entity type:Individual
Prefix:
First Name:MARRIANNE
Middle Name:
Last Name:RYNO
Suffix:
Gender:F
Credentials:RPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 W TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0536
Mailing Address - Country:US
Mailing Address - Phone:573-634-2628
Mailing Address - Fax:573-635-1768
Practice Address - Street 1:3721 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0536
Practice Address - Country:US
Practice Address - Phone:573-634-2628
Practice Address - Fax:573-635-1768
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist